Minding Your Child’s Mental Health

From the American Academy of Pediatrics:

The ongoing stress, fear, grief, and uncertainty created by COVID-19 pandemic has weighed heavily on children and teens. Many are having a tough time coping emotionally.

More than 140,000 children in the United States have experienced the death of a parent or grandparent caregiver from COVID, for example. Children of racial and ethnic minority families have been hit especially hard. Research shows they’ve had up to 4.5 times the risk of losing a caregiver to COVID, compared to other kids.

Many families have also lost jobs and had vital supports such as school, health care services, and other community programs interrupted. And many have experienced or witnessed a rise in racism and xenophobia during the pandemic, particularly toward families of Asian descent.

A rise in mental health emergencies

Since the start of the pandemic, hospitals have seen more mental health emergencies among kids. Between March and October 2020, the percentage of emergency department visits for children with mental health emergencies rose by 24% for children ages 5-11 and 31% for children ages 12-17. There was also a more than 50% increase in suspected suicide attempt emergency department visits among girls ages 12-17 in early 2021 as compared to the same period in 2019.

Even with the protection of the COVID-19 vaccines now available to children who are old enough for them, pandemic-related stress and traumas may have lasting effects on the developing minds of children and teens. Continue to check in with your child often and watch and listen for signs they are struggling. And remember that your pediatrician is here to help.

How is your child coping?

Invite your child to talk about how they are feeling. Feeling depressed, hopeless, anxious, and angry could be normal reactions to stress. However, if these feelings are constant and overwhelming–or if they affect your child’s ability to keep doing what they usually do, such as going to school, doing their work, or having fun–these may be signs they need more support during this difficult time.

Keep in mind that younger children may not know how to talk about these feelings, but may show changes in their development or behavior. Teens and young adults, meanwhile, may try to hide their feelings because they don’t want to bother others.

Recognizing signs of stress in your child

Signs of stress and mental health challenges are not the same for every child or teen, but there are some common symptoms.

Infants, toddlers and young children…

may show backward progress in skills and developmental milestones. They may also have increased problems with:

• fussiness and irritability, startling and crying more easily, and be more difficult to console.
• trouble falling asleep and waking up more during the night.
• feeding issues such as nausea and vomiting, constipation or loose stools, or new complaints of stomach pain.
• being anxious when they have to separate from their family, clinginess, not wanting to socialize, and fear of going outside.
• hitting, frustration, biting, and more frequent or intense tantrums.
• bedwetting after they’re potty trained.
• aggressive behavior.

Older children and adolescents…

may show signs of distress with symptoms such as:

• changes in mood that are not usual for your child, such as ongoing irritability, feelings of hopelessness or rage, and frequent conflicts with friends and family.
• changes in behavior, such as stepping back from personal relationships. For example, if your outgoing teen stops spending time or texting or video chatting with friends, this may be cause for concern.
• a loss of interest in activities previously enjoyed. Did your music-loving child suddenly stop wanting to practice guitar, for example? Did your aspiring chef lose all interest in cooking and baking?
• a hard time falling or staying asleep, or starting to sleep all the time.
• changes in appetite, weight or eating patterns, such as never being hungry or eating all the time.
• problems with memory, thinking, or concentration.
• less interest in schoolwork and drop in academic effort.
• changes in appearance, such as lack of basic personal hygiene.
• an increase in risky or reckless behaviors, such as using drugs or alcohol.
• thoughts about death or suicide, or talking about it (see “A word about suicide risk,” below.

How your pediatrician can help

Staying in touch with your pediatrician is more important than ever during this pandemic. If you have any concerns, ask your pediatrician’s office about checking on your child’s social and emotional health. This can be especially important for children facing higher rates of illness or risk from COVID-19, such as children of color, those living in poverty, special health care needs or developmental differences. Children who are refugees and those involved with the child welfare and juvenile justice systems​ may also be more at risk.

Pediatricians can screen for depression and ask about other concerns like anxiety or trouble coping with stress. The doctor may also ask about these symptoms in other family members, as this can impact your child’s health, and whether they know anyone who has become sick with COVID-19. It’s important to offer your teen some time to talk one-on-one with the pediatrician during the visit to ensure they have the chance to speak as openly as possible. Many pediatricians are also offering telehealth visits during the pandemic.

Dealing with the loss of a loved one to COVID-19

Children, adolescents, and families who experienced the loss of a loved family member or friend to COVID-19 are at increased risk for mental health challenges and may need special attention and professional counseling to manage their loss and grief.

Supporting your child

Your pediatrician can give you guidance on ways to best support your child and help them build resilience. Always check in with your child, ask them how they are feeling, and remind them you are there to talk if they want to, when they are ready. Some children or adolescents may need more time and space to express their feelings. Some may do better with gradual conversations and other activities besides talking, such as painting or drawing to express themselves and manage stress. Others might be more comfortable with direct conversations or activities.

A word about suicide risk

Rates of suicide for both adolescents and adults increase during times of high stress. In addition to screening for depression, your pediatrician can screen for suicide risk.

Remember, not everyone who considers suicide will talk about it, and not everyone who talks about suicide will act on their words. However, any talk about suicide should be taken seriously. If you are worried about your child, it is critical to make your home safe by removing weapons and ammunition from the house and securing medications in a locked cabinet.

Seek help immediately by calling the National Suicide Prevention Lifeline at 1-800-273-TALK or texting the Crisis Text Line by texting ‘TALK’ to 741741. Reserve 911 for situations where self-harming actions are happening or are about to happen. In a non-crisis situation, talk with your pediatrician about any concerns you have about your child’s mental health.

Self-care and setting the tone

Parents set the tone in the household. Expressing extreme doom or fear can affect your children. It can be challenging to stay positive, especially if you’re struggling with your own stress. But try to relay consistent messages that a brighter future​ lies ahead. It helps to set aside time to take care of yourself when possible, and seek the support you may need for your own mental health. Practicing mindfulness, focusing on the present moment, yoga or stretching can help the entire family build coping skills. Build in down time for the whole family to connect and relax, enjoying a nap, movie time or simply spending time together.

Remember

Keep lines of communication open between you and your child, and don’t hesitate to talk with your pediatrician about ways to help maintain your family’s mental health during this difficult time.

Holiday Gatherings: Tips to Protect Kids Too Young for COVID Vaccines

From the American Academy of Pediatrics:

For many families, the holidays are about getting together with relatives and friends. As COVID-19 surges again with new variants, chil​dren younger than 5 years old are not yet eligible for the vaccine. Even though children ages 5-11 years can get vaccinated against COVID, it takes two weeks after the second dose to be fully protected.

Everyone can play a role in protecting those at higher risk of severe illness as we gather together this holiday season. If you’ll be celebrating with unvaccinated children and other higher-risk loved ones, keep these tips in mind to help minimize exposure to COVID-19.

Getting together for the holidays safely

Celebrate with fully vaccinated family and friends. Limiting gatherings to fully vaccinated guests is the best way to protect young children who are not yet vaccinated, or individuals who have weakened immune systems. Encourage loved ones who are eligible to get fully vaccinated before gatherings. Encourage everyone 16 and older to get booster shots. For loved ones who are not vaccinated, consider joining by video chat for traditions such as cooking a favorite dish, opening gifts, or sharing words of gratitude before the meal.

Urge guests to stay home if they have symptoms of COVID-19. They should get tested if they have symptoms of COVID-19 or have a close contact with someone who has COVID-19. Do not host or attend any in-person festivities if you or anyone in your household has been:

• diagnosed with COVID-19 and is still at risk of spreading it to others
• has had any symptoms of COVID-19 within 48 hours of the gathering
• is waiting for viral test results; or has a known exposure to someone with COVID-19 within the last 14 days

Consider using COVID-19 at-home self-tests before gatherings of families from different households. You can use these tests, available over-the-counter, regardless of vaccination status or whether or not you have symptoms. Self-tests should be done no more than a day before the gathering. Anyone with a positive self-test should avoid get-togethers to reduce the risk of spreading disease to someone else.

For families with vaccinated and unvaccinated members, the safest way to prevent the spread of highly contagious COVID-19 variants is to wear masks at all indoor gatherings with others.

Additional ways to reduce risk:

• Keep the gathering small and short. Keep your guest list as small as possible and reduce the amount of time you would usually visit.
  
• Open windows and celebrate outside when possible. Open windows for better ventilation. If weather permits, gather outdoors.
  
• Consider an outdoor treat exchange. Another way to share the holiday spirit is to prepare traditional recipes for family and neighbors. Enjoy the treats outdoors with some hot cocoa or cider.
  
• Keep it clean. Remind children to wash hands often, and keep hand sanitizer within reach.

What about holiday shopping?

Wear masks while shopping indoors, especially in areas with substantial or high COVID-19 transmission rates. Avoid bringing children under 2 years old with you during holiday shopping trips, since they are too young to wear masks, or go when stores are not as busy.

Can we travel for the holidays?

Public health experts are still discouraging people who are not fully vaccinated from traveling for holiday gatherings. Families who must travel and have children who are not fully vaccinated should choose the safest travel options for their group.

If your child is too young for the vaccine, you may want to travel by car with members of your household who are vaccinated in a private vehicle, if possible. Wear a mask at gas stations and rest stops. If you must travel by air, be careful around large groups clustered at security lines and concourses, wear masks in airports and on planes, and hang back until lines have thinned.

Remember

Stay safe this holiday season and your family will be even more grateful for your traditions in the years to come.